Epipen or Benadryl

[B+.]

Really does need to be a STICKY on Eppipens!

Yeghes da

I've asked HM to make it a sticky (especially drex's comments). This topic comes up repeatedly and its very upsetting to go through it all each time.

 

[Hivemaker.]

I've asked HM to make it a sticky (especially drex's comments)

http://www.beekeepingforum.co.uk/showthread.php?t=35338

 

[Karol]

This topic is quite an emotional Pandora's box.

Epipens are prescription only and are intended only for those patients who have a known pre-disposition to anaphylaxis from known causes. In other words, for those people who have had previous serious allergic reactions.

I feel for you B+ and what you went through is unimaginable. The truth is though that the number of patients dying from anaphylaxis from bee/wasp stings is very very small and that's because in the vast majority of cases first aid and emergency services are generally adequate to prevent the vast majority of deaths.

So one has to ask what the benefit would be of making epipens available to more people especially those for whom it has not been prescribed and I would have to answer by saying 'none'!

Administering adrenaline in the wrong situation by an untrained and unqualified individual (i.e. for someone for whom the epipen was not prescribed) carries higher risk in my opinion than administering two chlorpheniramine 4mg tablets (to be chewed and wetted with saliva and the resulting paste held under the tongue before swallowing). Administering an epipen to someone for whom the epipen was prescribed who subsequently suffers anaphylaxis is a different issue entirely and I would still recommend sub-lingual chlorpheniramine.

The thing is B+, that even if you had adrenaline available and were trained to use it there's little if any guarantee that it would have changed the outcome for your son and that's because in my professional opinion there is a cohort of patients suffering anaphylaxis with concomitant Kounis syndrome where the administration of adrenaline is likely to have the opposite effect to that intended. When I review the incidents of those patients that have died from anaphylaxis there's a significant number that did receive timely emergency treatment including adrenaline and supportive therapy and they still passed away.

 

[dpearce4]

This topic is quite an emotional Pandora's box.

Epipens are prescription only and are intended only for those patients who have a known pre-disposition to anaphylaxis from known causes. In other words, for those people who have had previous serious allergic reactions.

I feel for you B+ and what you went through is unimaginable. The truth is though that the number of patients dying from anaphylaxis from bee/wasp stings is very very small and that's because in the vast majority of cases first aid and emergency services are generally adequate to prevent the vast majority of deaths.

So one has to ask what the benefit would be of making epipens available to more people especially those for whom it has not been prescribed and I would have to answer by saying 'none'!

Administering adrenaline in the wrong situation by an untrained and unqualified individual (i.e. for someone for whom the epipen was not prescribed) carries higher risk in my opinion than administering two chlorpheniramine 4mg tablets (to be chewed and wetted with saliva and the resulting paste held under the tongue before swallowing). Administering an epipen to someone for whom the epipen was prescribed who subsequently suffers anaphylaxis is a different issue entirely and I would still recommend sub-lingual chlorpheniramine.

The thing is B+, that even if you had adrenaline available and were trained to use it there's little if any guarantee that it would have changed the outcome for your son and that's because in my professional opinion there is a cohort of patients suffering anaphylaxis with concomitant Kounis syndrome where the administration of adrenaline is likely to have the opposite effect to that intended. When I review the incidents of those patients that have died from anaphylaxis there's a significant number that did receive timely emergency treatment including adrenaline and supportive therapy and they still passed away.

The advice about chewing the 2 tablets was given to me by A&E and said it should help until the paramedics arrive. I was also told to try and jog on the spot until totally out of breath as this will help the body produce its own adrenaline (ie fight or flight response).

I have one of those dummy pens but actually the best thing I have ever done for someone to learn was to get hold of a shoulder of pork and pretend it was my thigh and fire an out of date epi pen into it as if I were actually in need of the adrenaline. It is so much more realistic for the person doing the training. A trick given to me by someone that gives epi pen training for st johns staff.

The pork wasn't wasted it was slow roasted for a pulled pork dish after which was wonderful.

 

[B+.]

The advice about chewing the 2 tablets was given to me by A&E and said it should help until the paramedics arrive. I was also told to try and jog on the spot until totally out of breath as this will help the body produce its own adrenaline (ie fight or flight response).

I can't believe I am hearing this. It is complete and utter CRAP!
You people have no idea how fast this happens. His throat had closed. He couldn't breathe. His lips turned blue from lack of oxygen. We couldn't get piriton syrup into him let alone a tablet.
As for jogging on the spot..He couldn't even sit upright sitting in the car seat.He collapsed as I drove (like a madman) to get him to the doctors. I was later told that the best thing to do would have been to elevate his feet above his head to maintain blood pressure. How? He couldn't breathe!
I am trying very, very hard not to swear...but you guys have no idea what it was really like. I hope you never do...but, some of you seem determined to do just that

 

[dpearce4]

I can't believe I am hearing this. It is complete and utter CRAP!
You people have no idea how fast this happens. His throat had closed. He couldn't breathe. His lips turned blue from lack of oxygen. We couldn't get piriton syrup into him let alone a tablet.
As for jogging on the spot..He couldn't even sit upright sitting in the car seat.He collapsed as I drove (like a madman) to get him to the doctors. I was later told that the best thing to do would have been to elevate his feet above his head to maintain blood pressure. How? He couldn't breathe!
I am trying very, very hard not to swear...but you guys have no idea what it was really like. I hope you never do.

Don't get personal B+. I wasn't talking about your son, I was talking about the advice I was given TO ME and as a first port of call I would use it every time. I do know how fast it happens as it has to me.

Maybe you need to take a step back from the whole epipen debate. and maybe this thread should be closed before something is said that people regret.

 

[B+.]

this thread should be closed.

At last, something we can agree on.

I don't mean to minimise what happened to you, but, please don't tell me it was the same as happened to Simon. You survived.

 

[dpearce4]

At last, something we can agree on.

I don't mean to minimise what happened to you, but, please don't tell me it was the same as happened to Simon. You survived.

Indeed I did.

which is why I am able to talk about it now and do know what I am talking about. My throat was also almost closed by the time I got to A&E, unable to talk and just about able to breath.

The thing is that I was told about the tablet thing by a consultant with many years of training and experience and the advice was given so I had something I could do if I had another sting before I was able to get an appointment for my GP to be prescribed my epi pens.

I have always made sure that anyone who comes with me beekeeping knows were my pens are. I don't keep them in my beesuit as I have lost stuff from the pockets before but in my beekeeping equip box. They are told what they would need to do but also told to read the instructions on it if they have forgotten.

Many people think they should go in the buttock not the thigh (no idea where that has come from) and are surprised that it doesn't.

I have used the tablet advice on a number of occasions and it has ment me not having to use the epi pen those times so it can work as long as its done as quickly as possible when the realisation that it is happening.

And as I have said I will never use my epi pens on someone else they are for me and I have no idea if anyone who comes with me might have some other health problem that an epi pen may make worse. I do know there are some, I have a bicuspid aortic valve that leaks and there is the risk that the epi pen may cause me issues with that.

I have also been through desensitisation for the last 3 years which has been highly successful, but I am still allergic to stings even tho I don't react to them now (if tested it would show up).

I wont be posting on this thread again.

 

[Karol]

I can't believe I am hearing this. It is complete and utter CRAP!
You people have no idea how fast this happens. His throat had closed. He couldn't breathe. His lips turned blue from lack of oxygen. We couldn't get piriton syrup into him let alone a tablet.

I am sorry B+ for your loss. I'm deeply sorry that this subject is a raw wound for you that won't get any better or any easier.

I understand that your son could not swallow but with the sub-lingual route you don't have to swallow and that's the whole point. Not only do you not need to swallow, but drugs absorbed from under the tongue enter the circulatory system almost as quickly as if they were injected and they don't go through the liver so they are not broken down by the first pass effect. Because administration is under the tongue the chlorpheniramine enters the localised blood vessels that also supply the throat and tongue. In an emergency situation it's the best advice that I could give to try to combat the swelling of the tongue and throat to preserve the airway.

As for jogging on the spot..

Anaphylaxis doesn't always come on as quickly as in your son's case and jogging on the spot will help raise natural adrenaline levels. Again, we're talking desperate measures here and you do what you can with the situation you have at hand. If the casualty has collapsed or is on the verge of collapsing then clearly that won't work, but, if they are still able, then chlorpherimaine under the tongue whilst jogging will help get the drug into the circulatory system even more quickly as well as promote adrenaline production.

He couldn't even sit upright sitting in the car seat.He collapsed as I drove (like a madman) to get him to the doctors. I was later told that the best thing to do would have been to elevate his feet above his head to maintain blood pressure. How? He couldn't breathe!

When I lecture pest controllers on this subject I always say to them, don't drive the casualty to A&E. Call the emergency services and make it plainly clear to them that you have someone in anaphylaxis and that their throat is closing and they have difficulty breathing. The reason I give that advise is two fold. First is the fact that the emergency services will invariably be able to get to the casualty quicker than you'll be able to get them to the emergency services and they'll be able to initiate emergency treatment immediately on arrival and support the casualty during the journey. The second reason I give that advice is because you can't help or monitor the casualty whilst you're driving if it's only the two of you.

I am trying very, very hard not to swear...

I think you should scream out those swear words and not hold them in. I think you should hate me and scream abuse at me for saying the things I have and the things I'm about to - I'll understand. I believe you did everything possible for your son. I can't do anything to help you but I can help other people who might find themselves in a difficult position in the future. I have helped others successfully in the past. And I say this to anyone who wants to take professional advice around bee keeping or pest control:

Always have chlorpheniramine 4mg tablets (piriton) to hand which are in date and make sure you store them below 25°C (i.e. don't leave them in a hot vehicle over summer). Keep a bottle of water with you. Always carry a mobile or other device that you can use quickly if you need to and make sure it works in the area where you'll be working. If the charge is getting low, then don't take the risk - charge up the device first before starting work. If you have a mobile make sure the GPS system is enabled so that you can be tracked by the location of your mobile. If you can, let someone know where you'll be and for how long so that if things go wrong someone else will come looking and raise the alarm if need be.

Learn to recognise the cardinal symptoms of anaphylaxis - and I mean anaphylaxis as opposed to bad allergic reactions.

If you get stung and start showing cardinal signs of anaphylaxis, call 999 and ask for an ambulance immediately. Don't wait.

If you can then at the same time you're calling grab hold of two chlorpheniramine tablets and chew them into a fine paste with enough saliva to wet the paste but not so much that it gets diluted and washed away and manoeuver the crushed tablet paste under your tongue. The finer that you chew the tablets the quicker that the drug will enter your blood stream and start working. Hold the paste there for as long as you can. If you find that your mouth is too dry to form any saliva, and you can still swallow, then drink as much water as quickly as you can. If you can't swallow but can't form any saliva, use a small sip of water to form the paste.

If you are fit enough, jog on the spot with the chlorpheniramine under your tongue. If you feel like you're going to feint, lie down and raise your legs but try to keep pumping your arms.

but you guys have no idea what it was really like. I hope you never do...but, some of you seem determined to do just that

I am sorry for your loss B+ and for the continued pain it brings you!

 

[B+.]

Anaphylaxis doesn't always come on as quickly as in your son's case

But, people need to know that it can and be prepared for it. They may not get a second chance!

In the end, people will do what they want to do, or what they have prepared themselves to do with proper training. I know that I couldn't live with myself if I allowed that to happen again so anyone that comes into my apiary does so with the knowledge that I have an epipen available and will use it in an emergency.

The signs are not always visible, particularly when wearing a beesuit...thats why dialogue is so important. If someone is unresponsive, they can be in severe distress and you may not be able to see it.

 

[Karol]

But, people need to know that it can and be prepared for it. They may not get a second chance!

Of course it can.

In the end, people will do what they want to do, or what they have prepared themselves to do with proper training. I know that I couldn't live with myself if I allowed that to happen again so anyone that comes into my apiary does so with the knowledge that I have an epipen available and will use it in an emergency.

I haven't read all of this thread so please forgive me if you've already made this point elsewhere but what is the authority under which you have the epipen? Have you gone through some sort of recognised paramedic training and been certified as a first responder? If not, then you should consider doing so because that's the only way that you'll be safe and legal with an epipen in your possession. If you use an epipen prescribed for you and not the person who you use it on and they die because of maladministration then that'll be a tragedy of nightmarish proportions that'll far exceed what you've experienced to date because then you will be responsible for their death.

The signs are not always visible, particularly when wearing a beesuit...thats why dialogue is so important. If someone is unresponsive, they can be in severe distress and you may not be able to see it.

And they may have suffered a transient ischaemic attack whilst suffering heat rash from being confined in a hot sweaty bee suit which you mistake for anaphylaxis in your haste and biased state of mind.

B+ I have the greatest respect for you but please, leave the epipen for the professionals or become a professional yourself. Otherwise, follow the advice I've given you.

 

[B+.]

please, leave the epipen for the professionals

No. I am not a paramedic. I've seen enough tragedy to last me a lifetime.
I've said all I intend to say. I owe it to my son to do all I can to prevent this from happening to anyone else. Thats why I encourage people to get the required training and be prepared to use it in an emergency.
I've been through the legal side with doctors and lawyers and, of course, medical attention should be sought. What I am trying to prepare people for is the speed at which this can happen. Having an epipen available and knowing how to use it can make the difference to saving someone while an ambulance is en-route.
Its also important that an ambulance crew can get to the casualty safely. If there's an open hive of angry bees nearby, this can delay them from administering treatment.

 

[For want of a better word]

No. I am not a paramedic. I've seen enough tragedy to last me a lifetime.
I've said all I intend to say. I owe it to my son to do all I can to prevent this from happening to anyone else. Thats why I encourage people to get the required training and be prepared to use it in an emergency.
I've been through the legal side with doctors and lawyers and, of course, medical attention should be sought. What I am trying to prepare people for is the speed at which this can happen. Having an epipen available and knowing how to use it can make the difference to saving someone while an ambulance is en-route.
Its also important that an ambulance crew can get to the casualty safely. If there's an open hive of angry bees nearby, this can delay them from administering treatment.

As beekeepers we are possibly going to be the most likely people to see the consequences of bee stings.

TRAINING IS ESSENTIAL... as a scuba diver... as a yachtsman... as a motorcyclist.... emergency training for the specific hobby / sport , is given to those who wish to participate safely in areas that would not be usual for the general public. Accidents happen, and as many have stated before me on this thread TRAINING puts you into automatic response mode... no matter how many people are screaming and panicking around you!

If just one tragedy can be averted by a TRAINED beekeeper getting that VITAL couple of minutes of time for professional help to arrive by the administration of Adrenalin in the case of shock following acute anaplalyxis
I for one would be prepared to carry Eppipens.

END.
Gorfenna

 

[Swarm]

Too many experts, IMO. My suggestion to the OP would be to get medical advice from a doctor rather than faceless names on a forum.

 

[For want of a better word]

Too many experts, IMO. My suggestion to the OP would be to get medical advice from a doctor rather than faceless names on a forum.

Problem is that a lot of GPs are unsure... perhaps they need training too!

GORFENNA